If any portion of your group life insurance coverage terminates, you may be able to continue your life insurance protection. Your right to do this is called a conversion privilege, and its features are described here.
ET-2305
Form
Active Employee /
Local Employer /
State Employer
Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.
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